Baseline prevalence of high blood pressure and its predictors in a rural adult population of Bangladesh: Outcome from the application of WHO PEN interventions

Self-reported prevalence of asthma and its associated factors among adult rural population in Bangladesh: a cross-sectional study using WHO PEN protocol

OBJECTIVE

For over a decade, the prevalence of asthma remained unchanged at around 7% in Bangladesh. Although asthma causes significant morbidity among both children and adults, updates on epidemiological data are limited on the prevalence in Bangladesh. This study attempted to determine the prevalence of asthma, and its modifiable and non-modifiable lifestyle predictors in a rural population of Bangladesh.

METHOD

This study was part of a cross-sectional study that applied the WHO Package of Essential Noncommunicable Disease Interventions via census in a rural area of Bangladesh, where self-reported data on asthma were recorded. Data on anthropometric measurement, sociodemographic characteristics and behavioural risk factors were collected following the standard protocol described in the WHO STEP-wise approach to surveillance (STEPS) questionnaire. Analysis included descriptive statistics to assess the prevalence of asthma and its risk factors, and binary logistic regression to determine contributing factors.

RESULT

The overall prevalence of asthma was 4.2%. Asthma was predominant among people above 60 years (8.4%). Higher asthma was noted among males (4.6%), self-employed (5.1%), with a family history of asthma (9.1%), with comorbidities besides asthma (7.8%) and underweight (6.0%) compared with their counterparts. The OR of having asthma was 1.89, 1.93, 1.32, 1.50, 2.60, 0.67, 0.67 and 0.78 if a respondent was 45 years old or more, married, underweight, ever smoker, with a family history of asthma, housewife, employed and consumed red meat, respectively, while considering all other variables constant, compared with their counterparts.

CONCLUSION

The study emphasised asthma to be a public health concern in Bangladesh, although it seems to have decreased over the last decade. Among others, red meat intake and nutritional status were strongly associated with asthma, and the linkage among these is still a grey area that needs further exploration.

Baseline prevalence of hyperglycemia and its predictors among community clinic users of a selected rural area of Bangladesh: A cross-sectional study using the WHO PEN Protocol 1

AIMS/INTRODUCTION

Our objective was to estimate the prevalence of hyperglycemia at baseline, and identify its predictors among community clinic (CC) users from a selected rural area of Bangladesh.

MATERIALS AND METHODS

This cross-sectional study partly used the baseline data of implementation research in which a total of 11,244 adults visited the CC, and their blood glucose, blood pressure and anthropometry were evaluated according to 'Action 2' of the World Health Organization (WHO) Package of Essential Noncommunicable Disease Interventions (PEN) protocol 1. Of these, 11,144 had complete information on demography, chronic diseases and their risk factors, which were collected during the implementation of 'Action 1' of WHO PEN protocol 1 at the household level. Hyperglycemia, prediabetes (PreD) and type 2 diabetes were diagnosed using the WHO criteria.

RESULTS

Using WHO PEN protocol 1, the estimated baseline prevalence was 12.5% for hyperglycemia, 3.4% for PreD and 9.2% for type 2 diabetes, and was more prevalent among men compared with women. PreD and type 2 diabetes had significantly higher odds ratio (OR >1) of having common risk factors as follows: age ≥40 years (PreD, P < 0.001; type 2 diabetes, P < 0.001), generalized obesity (PreD, P < 0.001; type 2 diabetes, P = 0.005) and hypertension (PreD, P < 0.000; type 2 diabetes, P < 0.001). Furthermore, participants with a family history of diabetes appeared to be a significant predictor of type 2 diabetes (P < 0.001), but not for PreD (P = 0.303).

CONCLUSIONS

Hyperglycemia, preD and type 2 diabetes showed a comparatively high prevalence among the CC users of the selected rural area. Obesity and hypertension are the key modifiable risk factors that should be reduced using a CC-centered risk reduction strategy.

Cascade of diabetes care in Bangladesh, Bhutan and Nepal: identifying gaps in the screening, diagnosis, treatment and control continuum

Diabetes has become a major cause of morbidity and mortality in South Asia. Using the data from the three STEPwise approach to Surveillance (STEPS) surveys conducted in Bangladesh, Bhutan, and Nepal during 2018-2019, this study tried to quantify the gaps in diabetes screening, awareness, treatment, and control in these three South Asian countries. Diabetes care cascade was constructed by decomposing the population with diabetes (diabetes prevalence) in each country into five mutually exclusive and exhaustive categories: (1) unscreened and undiagnosed, (2) screened but undiagnosed, (3) diagnosed but untreated, (4) treated but uncontrolled, (5) treated and controlled. In Bangladesh, Bhutan, and Nepal, among the participants with diabetes, 14.7%, 35.7%, and 4.9% of the participants were treated and controlled, suggesting that 85.3%, 64.3%, and 95.1% of the diabetic population had unmet need for care, respectively. Multivariable logistic regression models were used to explore factors associated with awareness of the diabetes diagnosis. Common influencing factors for awareness of the diabetes diagnosis for Bangladesh and Nepal were living in urban areas [Bangladesh-adjusted odd ratio (AOR):2.1; confidence interval (CI):1.2, 3.6, Nepal-AOR:6.2; CI:1.9, 19.9].

Prevalence and determinants of hypertension among urban slum dwellers in Bangladesh

Background

In low- and middle- income countries such as Bangladesh, urban slum dwellers are particualry vulnerable to hypertension due to inadequate facilities for screening and management, as well as inadequate health literacy among them. However, there is scarcity of evidence on hypertension among the urban slum dwellers in Bangladesh. The present study aimed to determine the prevalence and factors associated with hypertension among urban slum dwellers in Bangladesh.

Methods

Data were collected as part of a large-scale cross-sectional survey conducted by Building Resources Across Communities (BRAC) between October 2015 and January 2016. The present analysis was performed among 1155 urban slum dwellers aged 35 years or above. A structured questionnaire was adminstered to collect data electronically and blood pressure measurements were taken using standardised procedures. Binary logistic regression with generalized estimating equation modelling was performed to estimate the factors associated with hypertension.

Results

The prevalence of hypertension was 28.3% among urban slum dwellers aged 35 years and above. In adjusted analysis, urban slum dwellers aged 45–54 years (AOR: 1.64, 95% CI: 1.17–2.28), 55–64 years (AOR: 2.47, 95% CI: 1.73–3.53) and ≥ 65 years (AOR: 2.34, 95% CI: 1.47–3.72), from wealthier households (AOR: 1.94, 95% CI: 1.18–3.20), sleeping < 7 h per day (AOR: 1.87, 95% CI: 1.39–2.51), who were overweight (AOR: 1.53, 95% CI: 1.09–2.14) or obese (AOR: 2.34, 95% CI: 1.71–3.20), and having self-reported diabetes (AOR: 3.08, 95% CI: 1.88–5.04) had an increased risk of hypertension. Moreover, 51.0% of the participants were taking anti-hypertensive medications and 26.4% of them had their hypertension in control.

Conclusions

The findings highlight a high burden of hypertension and poor management of it among the slum dwellers in Bangladesh requiring a novel approach to improve care. It is integral to effectively implement the available national non-communicable disease (NCD) control guidelines and redesign the current urban primary health care system to have better coordination.